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How is a pharmacy reimbursed for Medicaid if a drug is not on the FUL list?

1 Answer

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Final answer:

Pharmacies are reimbursed for drugs not on the FUL list through the Average Manufacturer's Price (AMP) reimbursement model.

Step-by-step explanation:

Pharmacies are typically reimbursed by Medicaid for drugs that are not on the Federal Upper Limit (FUL) list through the Average Manufacturer's Price (AMP) reimbursement model. Under this model, pharmacies are reimbursed based on the average price that manufacturers charge for a drug. This ensures that pharmacies are compensated for the drug even if it is not listed on the FUL.

For example, if a drug is not on the FUL but its average manufacturer's price is $100, the pharmacy would be reimbursed based on this price. However, it's important to note that the actual amount reimbursed may vary depending on the specific state's Medicaid program.

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